Piggyback PC IOLs were explanted in 2 cases because of a newly described complication, interlenticular opacification. Three surgical means may help prevent this complication: meticulous cortical cleanup, especially in the equatorial region; creation of a relatively large continuous curvilinear capsulorhexis to sequester retained cells peripheral to the IOL optic within the equatorial fornix; insertion of the posterior IOL in the capsular bag and the anterior IOL in the ciliary sulcus to isolate retained cells from the interlenticular space.

Although a silicone IOL shows maximal adherence to silicone oil, other lens biomaterials are not immune to this complication. Silicone oil coverage was related to the dispersive energy component of the surface charge of the IOL biomaterial. Low dispersive energy materials had less silicone oil coverage, while those with higher dispersive energy had more oil coverage.

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We report the results of laser in situ keratomileusis (LASIK) in a 58-year-old woman with a history of corneal guttata in the right eye and mild Fuchs' dystrophy in the left eye. Preoperative pachymetry was 586 microm and 656 microm, respectively. The surgical treatment was +1.50 diopters (D) in the right eye and +3.25 D in the left eye. Surgery was performed using a VISX S2 Star laser and a Hansatome microkeratome with a 9.5 mm ring. Postoperatively, edema in the right eye resolved and pachymetry returned to 585 microm, but the left cornea decompensated despite maximum medical therapy and had a final pachymetry of 779 microm. The patient was referred to our cornea service for penetrating keratoplasty, which was performed 14 months after the LASIK treatment.

Scedosporium prolificans is a soil saprophyte that is associated with a large variety of infectious processes and with respiratory colonization in immunocompetent and immunocompromised patients. We report the first described case of S. prolificans keratouveitis associated with the intraocular long-term retention of a contact lens in a 76-year-old female patient. CASE REPORTA 76-year-old female was seen in February 2000 with an 8-week history of acute keratitis of the left eye. Ten years previously, she had started to wear contact lenses to correct her presbyopia. She wore the lenses for 6 months, at which time she apparently lost them and returned to using eyeglasses. Three days later, the right contact lens was found in the patient's right superior conjunctival fornix and removed. The left contact lens was never found and was believed to have been dislodged on its own. However, the patient started to experience a constant feeling of a foreign body in the left eye with lacrimation and discharges. She was diagnosed with keratitis of the left eye of unknown etiology and was started on ciprofloxacin eye drops after Staphylococcus aureus was isolated from the left corneal scrapings. Although the condition improved, it did not resolve completely, and over the course of the next 10 years the patient received medical management periodically, including a variety of antibiotics, topical steroids, and artificial tears for acute exacerbations of chronic keratitis. The most recent exacerbation occurred in December 1999, when the patient was treated with amoxicillin-clavulanate potassium (Augmentin) orally and a 0.3% tobramycin ophthalmic solution (1 drop four times daily).In February 2000, an examination revealed mild swelling of the left upper eyelid. The eyelid was inverted, and the tarsal border was lifted with a glass rod. A necrotic mass that was easily removed with forceps became visible. The mass had numerous, variously sized, cauliflower-like growths and was covered by a whitish membrane on the superior surface.A portion of the mass was sent for histological examination. Hematoxylin-and-eosin-stained sections of the mass revealed extensive areas of necrotic tissue surrounding the long-lost contact lens. Lymphocytes and plasma cells had infiltrated the periphery of the necrotic tissue around the lens. Septate hyphae within the necrotic tissue were visualized with Grocott methenamine silver nitrate stain (8) (Fig. 1). Gram-positive bacteria were demonstrated with Brown-Hopps Gram stain (3).The ophthalmologist inoculated a portion of the mass directly onto a Trypticase soy agar plate with 5% sheep blood, a chocolate agar plate, thioglycolate broth (for anaerobic culture), and a Sabouraud dextrose agar slant. None of the mass was submitted for direct examination by Gram staining or KOH staining. Additional specimens were submitted in viral transport medium for herpes simplex virus, cytomegalovirus, and Chlamydia trachomatis cultures. These latter cultures never grew.Blood and chocolate agar plates grew S. aureus after o...

Intraocular lenses with a hydrophilic optic have less tendency toward adherence to silicone oil than more hydrophobic designs. A foldable silicone IOL with heparin surface modification can significantly reduce potential silicone oil adherence, comparable to the level achievable with the rigid HSM PMMA designs. Two new foldable IOL styles, the HSM silicone IOL and IOLs in the general class of hydrophilic-acrylic, were highly efficacious in reducing silicone oil adherence. There is now a real choice of foldable lenses for patients with actual or potential vitreoretinal diseases.

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